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HomeMy WebLinkAbout25879-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27659 Date: 05/08/01 THIS CERTIFIES that the building NEW DWELLING Location of Property: 746 COX NECK RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 113 Block 12 Lot 10 .2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 12, 1999 pursuant to which Building Permit No. 25879-Z dated JULY 19, 1999 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED 2 CAR GARAGE & COVERED FRONT ENTRY AS APPLIED FOR. The certificate is issued to JAMES H. & SHARON M. JACOBS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0124 10/31/00 ELECTRICAL CERTIFICATE NO. 48624 12/05/00 PLUMBERS CERTIFICATION DATED 05/21/00 PECONIC PLUMBING & HEAT. /� 4f //Utho,.fized Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST $E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 25879 Z Date JULY 19, 1999 Permission is hereby granted to: JAMES JACOBS P 0 BOX 585 MATTITUCK,NY 11952 for CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED 2 CAR GARAGE & COVERED FRONT ENTRY AS APPLIED FOR. at premises located at 746 COX NECK RD MATTITUCK County Tax Map No. 473889 Section 113 Block 0012 Lot No. 010 . 002 pursuant to application dated JULY 12 1999 and approved by the Building Inspector. Fee $ 1,070 . 60 Authored Sig ORIGINAL Rev. 2/19/98 Form No. 6 O 3 7 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of .property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '-'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, •building and unusual natural or topographic features, y2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building•$25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin¢ - $100.00 3. Copy of Certificate of Occupancy - .250 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential /$15.00, Commercial $15.00 Date . . . . [.I a/0 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . /� old Or Pre-existing Building. . . . . . . . . . . . . . Location of Property. . .?:[ .G . . . . . Co, V.f=C_ : fZ�. MAZ7T [ TJc_Gc House No. Street Hamlet Sr=Frnr-_s H. SM{przc>" /1 I . SgcoGJ :-, . Onwer or Owners of Property.. . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . . . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . .. . . . . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . .. . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . a� Fee Submitted: $. . . . ... . . ' . . . . . . . . . . . . . . . . . . . . . O .X' s9N13 Co Z�0•7�O,S � PLIC T x t�t�•� v. '�Y / Ori . �'S•. .°• t. y? it'K• ✓:- ;Ilii'Vyis. .3 App 1SS: .iih� •yi.r t.) .;i:��r r, s. r:;i �yS'S r17!.rY S, !Ij ,t. avi',•r�'Yi:'.. . ,`,rNi.. 4t'ii yy ,yF 4SPi; itiiGS iiv;; ci i�,.i.2�i'`'y:. ;.,,,ri5r,' �SY,v� ,,. .i ! R •s ,� �,; ,rl 'r , r F;, r,rF� r"F,. ,,t,,. yr}„„. .,.{,,, ;ri�•� :'i;F(n,.s,;,.z• .,.t.s6,i ._.;Ft;,,t,r t,;... :;�+•r��ror); rtl..tfi,,. Mr ` i xhr�,:.:,;arS.�� :,1 ,�'t, .?ir,r, r;((, r„ „1,.. ,,tr, ,,;;, :z,,a„ i;�,�•• ' 'r,'g!rZt,•;::�n;a;_...x ::�i''. a. 1). ••la�, :•'�•�r 1, /� r,,r., 5r 1.. .�l Sd,.:rt;�, 1,. .,}rV,!,.,:'3 r+1.Y:.N.., r,t.v�S:'6 '::{5,:;.+n�ti'v4,?. ,n:- nx_.s, �.-r', ^;oi' �;a; ,:,r„ ..,r ,; `t. y«.ts...':`.;�+.,, s.a di '•,r:�x,.tti, `.�,c,,s'8'r i%,tfi`ti „ss�`1.,,r.Ax.,,',. ,tb` ' %�at „s�-?ts�':! ',-,.3 x' „� r{t!�'�i� '' r£�3{. q {i�i .i l lsi. }�,.,.,3f+tet f r. i i Y r ��.�'r ,y`?'ilur>•` �..,�,.\.: ail J>»L' ElectricalInspection certificate .�. `•`� %`� Electrical Inspection Service, Inc. : >, 375 Dunton Avenue East Patchogue, New York 11772 ` •3:� ft;,• (631)266.6642x:;, x) RK Date: 12/05/2000 Application No. : 48624 Issued to: Jim & Sharon Jacobs . c Street: 746 Cox Neck Road _? '4pr41s Village: Mattituck Zip: 11952 Town:Southold Lot: =~ Section: Block: 'a?• Introduced by: Glen's Electric Lic.# 4770-E was examined and found to be in comp/iancs with the Alotiono/Electrical Code c ElAttic Q1st Floor ❑ O/S Residential ElPool ❑ Det. Garage •,,. ❑ Basement 2nd Floor ❑ O/S Commercial ❑� Hot Tub ❑ NV Defects �x�'�`�- ••. i<tF,, Switches Receptacles Fixtures GFI Heaters A/C Fans >. 55 75 42 9 1 %''_''•.•••> Dishwasher Washer/Amp Dryer/Amp Oven Range/Amp Garbage Disposal 1 1 20 1 30 1 Furnace Oil Gas Circulator Smoke Detector Bell Transformer «Klt N»i =, r Meter Amps Phase Motors Telephone Television Carbon Monoxide acu' 300 Other Equipment:kU : , uacaum system ;;:,, � $` -- Hugo S. Surdi President JThis certificate must not be altered in any manner I \`=: :•� Building Permit No. L Inspectors may be identified by their credentials �t %)!�iv r .`v S �`ivii tj"^�{ �r Y� i1!'� �iii :'�yi-;S'� Sim •Y r �':ii� ::�� .i;i,£/ 1:•:: ,,n+ r R . .ems.n�ln {.a r ',.a.. -..t, �) r 1•r 4. •R s ' i 'r A1' rN+” {Ji•:t .t Sr ri: r•q,,. 't%�irn nrt '.n '!a � :'iiti"• :)•lay; 'i'I r i ^ft"iSi,.✓' A t�`:• •. (Irr r r••t`�'!' "�i'J7. ` •<.' r }, r Pr'` .lir A.• :'}71i�:C Rt.P r s %!r i r r.r���tji'!i . .rrr't`�'•aTri r �:.jS){i}!!t Sy,ti,..�@!t• "�!%S.SfiCr}i'' Riifr44!'{!!� ".{V'iP':w•M"••'SSrrp7r)ri•� 'a'J.yr'!!i• •iS'J'N:!}! ..al%',rr)r!= i.'i••r}' ,�.:' :SdVJrfl. ':S,SryN ::::%irVJlr 'y'i:•'(:'!'' 'y:1i:•1l::yl ;.... ,,,'V.. Uaa i ..-a?1 .Sae S.1r���..A�il�•t'�l•�]�j�,��/t.'��f •�1,'r�I£����% F ELECTRICAL INSPECTION SERVICE INC. 375 DUNTONAVENUE EAST PATCHOGUE,NEW YORK 11772 (516)286-6642 33309 DATE: 70120100 APPLICATIONNo.ONFILE . VILLAGE., Mattituck TOS` Southold ADDRESS.- 746 Adam c &treat ISSUED TO Jim Jacobs _ INTRODUCED BY: Glens Electric(L) LICNo: _320-E -" _- — "`"`astG uaml`ned on ///24/49- andjob'e in co`mplia`nce witTt lh-ealioN n�ctrica7 C`o`de LOCATION: Base.. 1st . . 2nd 3rd Attic Det.Garage Hot Tub Pool SWITCHES RECEPTACLES FIXTURES I HEATERS I FANS G.F.L AIR.COND. - DISHWASHER DRYER CLOTHES WASH. GAR.DISP. - RANGE 6PEN "SMOKE DETECTOR FURNACE OIL GAS I CIR. IMOTORS I BELL IRAN. SERVICE DISCONNECT ; METER AMPS, PXASE L 30OU/G OTHER EQUIPMENT Outside Res. Service Only .. --------e�UGO SURDI PRESIDENT .P UILDING PERMIT NO. The ceNtioete toned not be alteredi any reanner,. Inspectore nmy be identified by their credentials BLUE ORIGINAL YELLOW COPY PINK COPY OFFICE - - Town Hall, 53095 Main Road C2 C* Fax(516)765-1823 P. 0. Box 1179 Telephone(516)765-1802 Southold, NewYork 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T 1 0 N DATE: fzA1/0 0 Building Permit No. Owner: IzLn65 7--'V-ee' (please print) Plumber: -W'-O�u 1114-",Ive, evA�71 14-d- (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers /gignature) r i, z Sworn to before me this �Xaho--ra STEP�e BARBARA ow '20ad Notary Public,State of Now YCA -21 day of No.OIST4V,4752 Qualifled in Suffolk Councy, Commission Expires Sep.30.�w Notary Public, SU'46-U County %UFFOJ,(co S� Gyp Town Hall,53095 Main Road N Z Fax(631)765-1823 P.O.Box 1179 Telephone(631)765-1802 Southold,New York 11971-0959 y�jfo� w� BUILDING DEPARTMENT TOWN OF SOUTHOLD April 10, 2001 JAMES & SHARON M. JACOBS P.O. BOX 585 MATTITUCK, N.Y. 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : XX An application for Certificate of Occupancy is not on file . (Enclosed) XX No Underwriters Certificate on file . XX The check is (not on file . ) $25 . 00 XX No Health Department Approval on file . No final inspection has been made . XX No Plumber Solder Certificate on file . (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 25879-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. I 765-1502 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ) FIREPLACE & CHIMNEY REMARKS: 0/G ,DATE ® INSPECTOR LD INSPECTION REPORT DA = COM4NTS I / K s NDATION ( 1 ) f M�/!9�s art syat•!� /�.o e�.t(3�[csg� wd' ZL N �. -NDATION====(2ND) i N IGH FRAME111101 PLUMBING ry u ' SULATION PER N. Y. Ly STATE ENERGY CODE G p N q q _____-_ Ole __ u n u � FINALp--_–�--- 'u AD TIO C_ N-S: ok 4 �1! O/ 00, v ` rb o_ z� -- - c� --— - ca i A44- M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU ION [ ) FRAMING [ INAL [ ) FIREPLACE S CHIMNEY REMARKS: ,DATE INSPECTOR 5T7 ?- M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ =ROPLBG. FOUNDATION 2ND [ TION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: �L^ . ✓vi' y '/ __ DATE Y INSPECTOR l M-1802 BUILDING DEPT. INSPECTION [ ] F NDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ) FIREPLACE A CHIMNEY REMARKS: . C DATE INSPECTOR M-1802 BUILDING DEPT. 1 NSPECTIO [ ] FOUNDATION IST [ ROUGH PLBG. [ ] F .NDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ FIREPLACE & CHIMNEY REMARKS: �dqQ� ✓/ 1 ' Z DATE �� 'f INSPECTOR A 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND j ] INSULATION- [ ] FRAMING [ ] FINAL [ J FIREPLACE A CHIMNEY REMARKS: AT INSPE FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 25879 Z Date JULY 19 , 1999 Permission is hereby granted to: JAMES JACOBS P O BOX 585 MATTITUCK,NY 11952 for CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED 2 CAR GARAGE & COVERED FRONT ENTRY AS APPLIED FOR. at premises located at 746 COX NECK RD MATTITUCK County Tak Map No. 473889 Section 113 Block 0012 Lot No. 010. 002 pursuant to application dated JULY 12 1999 and approved by the Building Inspector. Fee $ 11070 . 60 i Authoxlzled Sign ture ORIGINAL Rev. 2/19/98 } COUNTY OF SUFFOLK All ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES - - - MARY E. HIBBERD, M,D.,,M.P.H. COMMISSIONER PERMIT THE ATTACHED PLAN, WHEN DULY SIGNED, BY A REPRESENTATIVE OF THE _ DEPARTMENT, CONSTITUTES A .PERMIT TO CONSTRUCT A. WATER SUPPLY. AND/OR 'A SEWAGE DISPOSAL. SYSTEM FOR THE PROPERTY AS DEPICTED. CONSTRUCTION MUST CONFORM WITH APPLICABLE,"STANDARDS INCLUDING THE STANDARDS FOR CONSTRUCTION OF SUBSURFACES 'SEWAGEDISPOSAL SYSTEMS FOR SINGLE FAMILY.RESIDENCES AND STANDARDS AND PROCEDURES FORTRIVATE WATER SYSTEMS. THE PERMIT (PLAN) EXPIRES THREE (3) YEARS AFTER THE APPROVAL DATE. ANY. MODIFICATIONS WHICH MAY AFFECT THE PROPOSED SEWAGE DISPOSAL SYSTEM'OR WATER SUPPLY_ REQUIRE SUBMISSION OF A REVISED PLAN AND ANY ADDITIONAL FEES, PRIOR TO CONSTRUCTION. NO INSPECTIONS WILL BE PERFORMED BY,THE DEPARTMENT ON EXPIRED PERMITS. PERMITS MAY BE REISSUED UPON . THE SUBMISSION OF NECESSARY APPLICATIONS, PLANS AND "FEES, AND ,WILL BE REQUIRED TO MEET THE STANDARDS IN EFFECT AT THE TIMEOF REISSUANCE. A PERMIT MAY BE TRANSFERRED INTO ANOTHER PARTY'S NAME UPON RECEIPT OF WRITTEN PERMISSION FROM, THEORIGINAL APPLICANT AND THE "RECEIPT OF, ANY REQUIRED TRANSFER FEES. IPL THIS CASE,_THE PARTY PAYING THE ORIGINAL APPLICATION FEE_ WILL' BE4 CONSIDERED TO BE THE ORIGINAL APPLICANT. WWM-05 8 ' PAGE 1 OF 2 DIVISION OF ENVIRONMENTAL QUALITY - - COUNTY CENTER - ' RIVERHEAD. N.Y. 11901-3$87 _ - - 852-2100 18-380..12/92" INSTRUCTIONS FOR FINAL AEEROVAL OF CONSTRUCTED SYSTEMS It is the applicant's responsibility to call the Department to arrange inspections of the sewage disposal system and water supply facilities prior to backfilling.I These include inspections of the soil excavation for the sewage disposal system and inspections of the water supply well, well lateral,public water supply line, disposal system,piping and filial grading. Other inspections may be quired. Following satisfactory construction land inspections: I. The applicant must submit 4 prints of an as-built plan(up to and including I Vx17"), by a licensed design professional, of the subject property showing the following: a. the lot location and dimension s; b. the lot number(s) and the name of the subdivision, if applicable; c. permanent structures (i.e.,buildings,driveways,walkways, swimming pools, decks,etc.); d. the exact location of the privlAte well, if applicable (give at least 2 dimensions measured from the comers of the building); e. the exact location of the pubic water line, if applicable; f. the exact location of the septic tank and leaching pool(s), if applicable. Give 2 dimensions from the building corners to the covers of the se tic tank and each leaching pool; g. the exact location of the sew r line from the dwelling to the street; if applicable; and h. have a clear area at least 3 x5" for the Department's approval stamp. 2. The applicant must submit a certificate from the sewage disposal installer attesting that the system has been installed according to the criter�a of the Suffolk County Department of Health Services, when applicable. 3. If a well has been installed as tie potable water supply, the applicant must submit a current well water analysis (within one year) and a well dr Her's certificate. If the well or water quality does not conform to standards,proof of corrective measures will be equired. Refer to "Standards and Procedures for Private Water Systems." 4. In those cases where public seers are utilized for the dwelling, the applicant is also to submit one (I) copy of the sewer line inspection approval from the public sewer district. In districts operated by Suffolk County, two (2) copies of Form S-9, duly executed by the Suffolk County Department of Public Works, are required. 5. In those cases in which the installation and connection of the public water service line has not been inspected by the Department of Health Services, a tap letter from the appropriate water company is required. HEALTH DEPARTMENT REFERENCE NUMBER MUST BE ON ALL CORRESPONDENCE OR DOCUMENTS SUBMITTED. SUBMIT ALL NECESSARY FINAL PAPERS AT THE SAME TIME. PHOTOCOP ES OF DOCUMENTS WILL NOT BE ACCEPTED. WWM-058 PAGE 2 OF 2 18.380-12/92 BOARD OF HEALTH . . . . . . . . . . . . . .. FORM NO. 1 3 SETS .OF PLANS . . . . . . . . . . . .. . . TOWN OF SOUTHOLD URVEY . . . . . . . . . . . . . . .. . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . .. . . . . . . . TOWN HALL SEPTIC FORM . . . . . .. . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: p Gy CALL lllS. . IQ.W. .CY �rn� Examined //� ., 19q ( -7 9 MAIL TO: . . . . . . . . . . . . . . . Apprw ,/ .., 19..;r Permit,No. .Y../..!..� .................................... Dia/c .................................. .................................... .................................................... �5 lvJ L�, a.=!•"�"'�{�@l i, _ ....�Building.i.... tot)... .... APPLICATION FOR BUILDING PERMIT Date. . . . .. . . . . . . . . . . . 19. . . . INSTRUCTIONS w-OG 0 t)TH1O1..O a eoe const be completely filled in by typewriter or in ink and submitted to the Building Inspector wi 3 sets ane, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upas approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MW to the Building Department for the issuance of a Building Permit pursuant to the Building Zane Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to cam pl with all applicable laws,_ordinances, building code, housing cafe, and - — - regulations, and to admit authorized inspectors on premises and in building for necessary inspections. a' (Signature of applicant, orAamb, if a corporation) p0. ... .BS...�'q:(tJ.U.(.r.......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plwi)er or builder ..................................................................................................... Name of owner of premises �Ft t11 G6 N• .. S ....nP7N m �S t4 G0/'S.S..SRss.......................... ......................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. .I.�) . ...... Plumbers License No. . ✓°) 5] !............ Electricians License No. .g7.7Q` ••..... Other Trades License No. .................... I. Location of land on which proposed work will be done.............................................................. Cox AJ(=C K AD.:. m �r.U.� ............. ................. ................. . ... House Number Street Hamlet Carty Tax Map No. 1000 nSection ... 30.0....'Block /a..'b.a... Lot ... �`.......... Subdivision .r!11��1 .I .SSaClf+ fE�........ Filed Map No. 0.9.0.4P. Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of,propose&,construction: a. Existing use and occupancy ..V!�......... �... (`?............................ .... ......,..,,.............. . b. Intended use and occupancy a _.. ....._.. ........ NX G)I14a46 .,eX...... iviuicion .......... Alteration .......... Repair ............ liemoval 'I......... Demolition ............ Other Work ................................ .. . ` (Description) 4. Estimated Cost ..�a:© a ........ fee .............................................. I (to be paid on filing this application) 5. If dwelling, rrnuber of dwellinggrnits ....J....... Nuvber of. dwelling units on each floor ......( ......... Ifgarage, nurber of cars .... y................................ 6. If business, connercial or mixed occupancy, specify nature and extent of each type of use...................... 7. Dimensions of existing structures, if any: Front................ Rear ............... Depth ................. Ileight ........................� Nurber of Stories ...................... Dimensions of same structure with alterations or additions: Front ............... Rear ............... Depth .................... Ileiglt ..................... Number of Stories ...Q.............. 8. Dimensions of entire new const:tion: FYont .... r l.i....... Rear ...59......... Depth J31. Height ........................1 Amber of Stories ....P.'.............. 9. Size of lot: Front I........ Rear ...�2C-5.Co31...... Depth .. 3ys`2:�% ....... 10. Date of Purchase ... I'...... Name of Former Owner .................................:...... A �1 II. Zone or use district' in which prrises are situated .....1.1. l ?..................... ....................:...... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...MQ..�s i 13. Will lot be regraded .... ^ ,C? ......... Will excess fill be removed from premises: YES 14. Names of Owner of premise J' .-2rgJ`�.!1:7 �7c.E'L'4�'4�Plwrre No.' .�57`-.��. Name of ContrNarre of tect !i TORI�6NTOa/r 4 i ynaF ,.. Address .. !ag .'2poCi�.......... Phare No.y77;0`fOD, . . .. .......... F} �ixkv6Ki �... Address -CMT" No. �S.5o�701 ... ..... . .... property r �... sric.p �/ I5. is Unis r within 300 feet of a tidal wetland? * YES .......... ND .l1,...... *IF YES, SOIMM MM TUS1109 PEIAIIT MAY RE WigffRED. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block neer or description according to deed, and show street names and indicate whether interior or corner lot. SrrciE Or Nim YORE, SS C"IT Or ....................... ...���C!tSQrU• .......1...................being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, / Ileis the ................Q w.r)�l......................................................................... (contractor, spent, corporate officer, etc.) of said owner or owners, and is duly anIItho''rized to perform or have performed the said work and to make and file this application; that all statements contat in this application are true to the beat of his knowledge and belief; and that the work will. be performed in the inner set forth in the application filed therewith. #worn to before onethis ......7...........da . .. .S. .l....l9. Notary Public ................ .. ...1 HELENE D.HORNE (Signature of Appli.can� Notary Public,Noc,State opf New York Qualified in Suffolk Cour,4� Commission Expires MPY r SURVEY OF LOT # 2 MAP OF "ADAM ASSOCIATES" f' r RI ht of way F I LED FEB. 7, I qui I , H Goa Neck Lane j� MAP �j /f - "Map of Huitpgu-grbo_r'" AS I�I/'ZI— # "IOb I SP Go.Mop a H b - - _ - �- SITUATE: MATTITUGK 613.33' TOWN OF 5OUTHOLD SUFFOLK GOUNTY, NY SURVEYED O6-Oq-qq a AMENDED 06-I-7-qq O AMENDED 06-2q-qq cL AMENDED 08-31-CM a SUFFOLK COUNTY TAX # U u 1000 - 113 - 12 - 10.2 h SGHD# RIO-980124 Lot# II w o I � 1 I I � I I I I I � N80°00'40"E �Q 265.63' SDR 4a, M ,ate a� g Lot#3 !N W o � z . Lot#2 I i` r, w S87'1640,W N 293.78, N CERTIFIED TO: JAMES H. JAOOE35 SHARON M. JA6055 R05LYN 5AVIN65 SANK GOMMONNEALTH LAND TITLE N51JRANGE GOMPANY #7001gIa12 OF NEg, NOTES: / / co .. . . _ ■ MONUMENT FOUND ] Q O PIPE FOUND Iii aee� SRI N�, 50��P��O AREA = 88,318 5F OR 2.26 ACRES /j^ SFo CA NO SV JOHN C. EHLERS LAND SURVEYOR GRAPHIC SGALE I11= 601 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.D:UOBSV9-172SK y SURVEY OF LOT # 2 ------- --------------------------------- ----- FILED — MAP OF "ADAM ASSOCIATES" �'w,pe M` nt pf spy F I LED FEB. from Gox �Seck Lpne I - "Map of deritppye Hprbor" � AS MAP # cIO61 1 SITUATE: MATTI TUGK 613.33' TOWN OF SOUTHOLD a� 1 SUFFOLK GOUNTY, NY Q ,g SURVEYED ob-oa-aa O AMENDED 06-1-7-99 py AMENDED 06-29-99 �C SUFFOLK COUNTY TAX # U 3 1000 - 113 - 12 - 10.2 00 v ° SGHD# RIO-890124 U m Lot# 1 w N CD w , o I I I I 1 Y ✓, � Ng\✓ate •g 0 00'gp"E �Q 265.63' 27) gD s o-o* m y. - a3, N �+b M Lot#3 m ey 1 N k TEST HOLE li from Piled mop t I C T" O o 00 Lot#2 �a g° oc! S87e E� PLEASE NOTE 16'40^Iy N Minimum distance between ell 29 3 0 and cesspool is to be 150 feet. �8' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT FOR APPROVAL OF CONSTRUCTION FOR A CERTIFIED TO: SINCLLE FAMILY RESIDENCE ONLY JAME5 H. JAGOB5 DATE F O. R lCJ'—q R 12 SHARON M. JAGOB5 ROSLYN 5AVIN65 BANK, APPROVED FOR MAXIMUM OF B DR MS NOTES: i EXPIRES THREE YEARS FROM DATE OF APPROVAL hQ ao�N C. Ey0 ■ MONUMENT FOUND r% t o¢ O PIPE FOUNDSIS 4,0. 50202 F� LANU SVP L AREA = 98,318 5F OR 2.26 ACRES - JOHN C. EHLERS LAND SURVEYOR GRAPHIC 56ALE 111= 601 6 EAST MAIN STREET N.Y.S.LIC.NO. 50202 RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF. D:UOBS\99-172 SURVEY - — - i1fRP OFRD,4M�SSOOGI ETES" _ ____ __ .e1rL dJl 50 wl RI V'"- qqnt°Fby FILED FEB. From Gox 17eck Lane "Map f ritage Harbor" � ' (' "` f1 r'� ;' ; . s�FloHe . Go. Map a AS MAP # aO61 I SITUATE: MA�TTITUGK 1 I'I 613.33' TOAN OF SOUTHOLD �; �, 1 ` SUFFOLK COUNT'(, NY SURVEYED 06-09-qg AMENDED 06-II-qq a, AMENDED 06-2q-99 AMENDED 08-31-qq I� FINAL 01-14-2000 ! 3 SUFFOLK COUNTY TAX # 1000 - 113 - 12 - 10.2 rn v' O to N SCHD# RIO-990124 Lot# 1 _ w N o iv ti o;. 00 I 1 I I I r 1/ 265.63• I � ( LERO 40 27 'qD agm car, 3,.�o v P 3yo fp Lot#3 N .r Or rLrtl L'Svo {ter C�fSii F'JR <t Mr r 4{ !'F IS [2-4� ,' r"'C4 7 to m „ . OCTr'�s n...r+"" -,.�.a at U11,( gf,v 'f.. �^ is ;.-1,r �3M It7, }- 15 Ff"I - p icy'• �a'a�i ��}- 4y � CO ry ti ;c S87'16,401'4, foa i 293,78, N rn GERTIFIED TO: JAMES H. JAGO55 SHARON M. JAGOE15 R05LYN SAVINGS BANK COMMONWEALTH LAND TITLE IN5URANGE GOMPANY #l0gq 1912 NE NOTES: !� � un.vtwnntl umuvn v wwuM w• ....r C/) :}e,:iion°ei nn It.eo°ifwntlr•"i:ine:21 .1 y p.R<n 9[•t•fnu[•[ltln LWne y ll -mb a eu.m.m.vntewl M emv venq ■ MONUMENT FOUND RF F ID—R R —D lay' T { u v p'.f.—°n..w to •n•u.nMy° mww m n. ,wni o- C uw- (inrn,ryt[M„vwn.r.vn.ww r.mm�Mu ii.. °n<M°,cn In wcYwMv O PIPE FOUND �F lQ, to".°mo.°von st°u.....r •um.1 aoN•m°u i L•no funww•, yltl lc•[I°n„Mwl °lr AREA = 88,318 5F OR 2.26 ACRES tiSFD LANG 9V ,no n::r..n::rte°:tn9: °'� .y.•fv.nnw ui .no on Mtl unm O.....lutw .,no..m m tn.°�.neMvt,n=o,lt . r runu- 0°n°°r°not RMUM•°,.to°[mutlwl Iwuwtl°nc JOHN C. EHLERS LAND SURVEYOR GRAPHIG 5GALE i"= 60' 6 EAST MAIN STREET N.Y.S.LIC.NO. 50202 RIVERHEAD,N.Y. 11901 J 369-8288 Fax 369-8287 REF. D:UOBS\99-172SK ' UNDERWRITERS CERTIFICATE OCCUPANCY 0R REQUIRED AP y OASNOTED USE IS UNLAWFUL EE, By:" ase WITHOUT CERTIFICATENOTIFY DE � 7651802 9ILDING AM TO =T&T OF OCCUPANCY l FOLLOWING INSPECTIONS: 1 h I FOUNDATION - TWO REQUIRED 1 FOR POURED CONCRETE - 2. ROUGH - FRAM NO i PLUMBING 3.' 4. FINAL-CONSTRUCTION MUST DO NOT PROCEED WITH 0. E COMPLETE FOR C. ALB CONSTRUCTION HALL MEET FRAMING UNTIL SURVEY o w o m THE REQUIREMENTS OF THE N.Y. OF FOUNDATION LOCATION STATE CONSTRUCTION & ENERGY NcoppertubiTlgl9used CODES. NOT RESPONSIBLE FOR NAS-6E ferWater distributing DESIGN OR CONSTRUCTION ERRORS CystSm.piping shell be of types K or L Only 7L ' UNDERWRITERS CERTIFICATE REQUIRED I I 2 \ - , z ' PLUMBING - / ALL PLUMBING WASTE TER LINES NEED I TESTING BEFORE COVERING a -. PROVIDE OPENINGS FOR M EMERGENCY ESCAPE AS m n — ' REQUIRED BY PART. 714 OF M- 1 N.Y. STATEBUIL- PROVIDE AIM40ALDAND/OR A THERMAL SHOCK PREVENTING • DEVICES AS TO PART.902.6(K) 111 STATE BUILDING CODE. I N PROVIDE% MR. FIRE RATED SEPARATION TO 2 PART. 717.3 (f)(1) OF N.Y. STATE - I _ BUILDING'CODE , = 1 f — - — I PROVIDE SMOKE-IDETECTING ALARM DEVICES -- --- - --------- _ ._ f _: - - --- - - - - --� -- IASTOPART.721.1 -_ — BUILDING CODE. � - - - - - - PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT I- - - - - - -- -- - - - EXCEED 2/1D-of 1%, tEAD. — — — - 'I"r iI' _ Stip�NGE . TGh 7r _ rl • iP s w ' pP8FES10N�� + n � } ,V I - 0 Rl I I Al - --- I I I � t�pF NEYO awl IYO , yhP rQ 022]5/-1 �A6 �OFESSIOMD 1 K 0 I W ..h Q a 1� I E ` 1 I w n E� f II NpF NEW Illi. 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